- Evolent (Olympia, WA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Cognizant (Olympia, WA)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- University of Washington (Seattle, WA)
- …Medical Center-Montlake - Dermatology Clinic** has an outstanding opportunity for a **Registered Nurse .** **WORK SCHEDULE** + Full time / 100% FTE + The anticipated ... phototherapy unit + Assist with prior authorizations and insurance appeals for specialty medications **REQUIREMENTS** + 2 years of...experience + Active licensure to work as a Registered Nurse in Washington State + Active BLS **ABOUT UW… more
- Molina Healthcare (Vancouver, WA)
- …will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and ... resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical peers. +… more
- Sharecare (Olympia, WA)
- …enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to medical, ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status +...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Molina Healthcare (Vancouver, WA)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends… more
- Providence (WA)
- …are terminal and nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing day to day ... the collaboration and management of patient care + Current unencumbered Registered Nurse License in state of residency **Preferred qualifications for this position… more